The role of septal cartilage in rhinoplasty: cadaveric analysis and assessment of graft selection

Overview

The septum is the first place surgeons look for graft cartilage during rhinoplasty. Its thickness is not uniform, and the right graft for each job depends on it. The authors removed the septal cartilage from cadavers, mapped its dimensions and thickness by region, and related the map to graft choice.

Sections of note

• Anatomical study on 14 fresh adult cadavers.
• Excised septal cartilage photographed on grid paper and divided into nine equal quadrants.
• Length, height, area and thickness measured; significance set at P < .05.
• Mean length 35.14 mm, mean height 32.5 mm, mean area 933.11 square mm.
• Mean thickness by quadrant ranged from 1.04 to 1.71 mm.
• Thickness differed significantly between quadrants in 13 of 14 cadavers; central and cranial areas thickest, the L-strut region thinnest.
• The septum is described as providing nearly 50% of airway resistance via the internal valve and as setting dorsal support and tip projection.

What it means for a patient

• The cartilage harvested from inside your own nose is a limited resource, roughly 3.5 by 3 cm, with the strongest part in the middle.
• The strip that must be left behind for support is the thinnest part, which is why surgeons preserve it carefully.
• Cadaver measurements from a small sample; living patients vary by age, sex and ethnicity, which the abstract does not address.

Why this paper matters

The study gives surgeons a thickness map for choosing which septal region to use for a spreader, strut or batten graft. Whether graft selection by region changes clinical outcomes is not tested.

Terms

• Nasal septum: the wall of cartilage and bone dividing the two sides of the nose.
• L-strut: the L-shaped rim of septum left in place after harvest to keep the nose supported.
• Internal nasal valve: the narrowest part of the nasal airway, between septum and upper lateral cartilage.
• Tip projection: how far the tip stands out from the face.
• Quadrant: one of the nine equal zones the authors divided the cartilage into.
• Cadaveric study: an anatomy study on donated bodies.